Insight into Cardioprotective Effects and Mechanisms of Dexmedetomidine

Overview

Journal Cardiovasc Drugs Ther

Specialties Cardiology & Vascular Diseases
Pharmacology

Date 2024 Jun 13

PMID 38869744

Authors

Leyu Jiang

Wei Xiong

Yuqiao Yang

Jinqiao Qian

Affiliations

Soon will be listed here.

Abstract

Purpose: Cardiovascular disease remains the leading cause of death worldwide. Dexmedetomidine is a highly selective α2 adrenergic receptor agonist with sedative, analgesic, anxiolytic, and sympatholytic properties, and several studies have shown its possible protective effects in cardiac injury. The aim of this review is to further elucidate the underlying cardioprotective mechanisms of dexmedetomidine, thus suggesting its potential in the clinical management of cardiac injury.

Results And Conclusion: Our review summarizes the findings related to the involvement of dexmedetomidine in cardiac injury and discusses the results in the light of different mechanisms. We found that numerous mechanisms may contribute to the cardioprotective effects of dexmedetomidine, including the regulation of programmed cell death, autophagy and fibrosis, alleviation of inflammatory response, endothelial dysfunction and microcirculatory derangements, improvement of mitochondrial dysregulation, hemodynamics, and arrhythmias. Dexmedetomidine may play a promising and beneficial role in the treatment of cardiovascular disease.

References

Li Z, Lin L, Wu H, Yan L, Wang H, Yang H . Global, Regional, and National Death, and Disability-Adjusted Life-Years (DALYs) for Cardiovascular Disease in 2017 and Trends and Risk Analysis From 1990 to 2017 Using the Global Burden of Disease Study and Implications for Prevention. Front Public Health. 2021; 9:559751. PMC: 8589040. DOI: 10.3389/fpubh.2021.559751. View

Afonso J, Reis F . Dexmedetomidine: current role in anesthesia and intensive care. Rev Bras Anestesiol. 2012; 62(1):118-33. DOI: 10.1016/S0034-7094(12)70110-1. View

Brock L . Dexmedetomidine in Adult Patients in Cardiac Surgery Critical Care: An Evidence-Based Review. AACN Adv Crit Care. 2019; 30(3):259-268. DOI: 10.4037/aacnacc2019888. View

Weerink M, Struys M, Hannivoort L, Barends C, Absalom A, Colin P . Clinical Pharmacokinetics and Pharmacodynamics of Dexmedetomidine. Clin Pharmacokinet. 2017; 56(8):893-913. PMC: 5511603. DOI: 10.1007/s40262-017-0507-7. View

Piao G, Wu J . Systematic assessment of dexmedetomidine as an anesthetic agent: a meta-analysis of randomized controlled trials. Arch Med Sci. 2014; 10(1):19-24. PMC: 3953974. DOI: 10.5114/aoms.2014.40730. View

Penttila J, Helminen A, Anttila M, Hinkka S, Scheinin H . Cardiovascular and parasympathetic effects of dexmedetomidine in healthy subjects. Can J Physiol Pharmacol. 2004; 82(5):359-62. DOI: 10.1139/y04-028. View

Kang D, Lim C, Shim D, Kim H, Kim J, Chung H . The correlation of heart rate between natural sleep and dexmedetomidine sedation. Korean J Anesthesiol. 2018; 72(2):164-168. PMC: 6458515. DOI: 10.4097/kja.d.18.00208. View

Geng Z, Liu Y, Wang S, Wang D . Intra-operative dexmedetomidine reduces early postoperative nausea but not vomiting in adult patients after gynaecological laparoscopic surgery: A randomised controlled trial. Eur J Anaesthesiol. 2016; 33(10):761-6. DOI: 10.1097/EJA.0000000000000491. View

Mahboobi S . Dexmedetomidine and Renal Protection after Cardiac Surgery. J Clin Anesth. 2017; 40:121-122. DOI: 10.1016/j.jclinane.2017.05.002. View

10.

Lin N, Vutskits L, Bebawy J, Gelb A . Perspectives on Dexmedetomidine Use for Neurosurgical Patients. J Neurosurg Anesthesiol. 2018; 31(4):366-377. DOI: 10.1097/ANA.0000000000000554. View

11.

Wong A, Smithburger P, Kane-Gill S . Review of adjunctive dexmedetomidine in the management of severe acute alcohol withdrawal syndrome. Am J Drug Alcohol Abuse. 2015; 41(5):382-91. DOI: 10.3109/00952990.2015.1058390. View

12.

Vega L, Sanchez-de-Toledo J, Gran F, Ortega J, Pujol M, Balcells J . Prevention of opioid withdrawal syndrome after pediatric heart transplantation: usefulness of dexmedetomidine. Rev Esp Cardiol (Engl Ed). 2014; 66(7):593-5. DOI: 10.1016/j.rec.2013.01.014. View

13.

Bao N, Tang B . Organ-Protective Effects and the Underlying Mechanism of Dexmedetomidine. Mediators Inflamm. 2020; 2020:6136105. PMC: 7232715. DOI: 10.1155/2020/6136105. View

14.

Yuki K . The immunomodulatory mechanism of dexmedetomidine. Int Immunopharmacol. 2021; 97:107709. PMC: 8324520. DOI: 10.1016/j.intimp.2021.107709. View

15.

Tang D, Kang R, Vanden Berghe T, Vandenabeele P, Kroemer G . The molecular machinery of regulated cell death. Cell Res. 2019; 29(5):347-364. PMC: 6796845. DOI: 10.1038/s41422-019-0164-5. View

16.

Chen S, Li A, Wu J, Huang Y, Zou T, Tailaiti T . Dexmedetomidine reduces myocardial ischemia-reperfusion injury in young mice through MIF/AMPK/GLUT4 axis. BMC Anesthesiol. 2022; 22(1):289. PMC: 9472426. DOI: 10.1186/s12871-022-01825-z. View

17.

Yang F, Zhang L, Zheng Y, Dong H . Dexmedetomidine attenuates ischemia and reperfusion-induced cardiomyocyte injury through p53 and forkhead box O3a (FOXO3a)/p53-upregulated modulator of apoptosis (PUMA) signaling signaling. Bioengineered. 2022; 13(1):1377-1387. PMC: 8805856. DOI: 10.1080/21655979.2021.2017611. View

18.

Peng K, Chen W, Xia F, Liu H, Meng X, Zhang J . Dexmedetomidine post-treatment attenuates cardiac ischaemia/reperfusion injury by inhibiting apoptosis through HIF-1α signalling. J Cell Mol Med. 2019; 24(1):850-861. PMC: 6933328. DOI: 10.1111/jcmm.14795. View

19.

Sun T, Gong Q, Wu Y, Shen Z, Zhang Y, Ge S . Dexmedetomidine alleviates cardiomyocyte apoptosis and cardiac dysfunction may be associated with inhibition of RhoA/ROCK pathway in mice with myocardial infarction. Naunyn Schmiedebergs Arch Pharmacol. 2021; 394(7):1569-1577. DOI: 10.1007/s00210-021-02082-6. View

20.

Wang T, Li Z, Xia S, Xu Z, Chen X, Sun H . Dexmedetomidine promotes cell proliferation and inhibits cell apoptosis by regulating LINC00982 and activating the phosphoinositide-3-kinase (PI3K)/protein kinase B (AKT) signaling in hypoxia/reoxygenation-induced H9c2 cells. Bioengineered. 2022; 13(4):10159-10167. PMC: 9161950. DOI: 10.1080/21655979.2022.2060900. View